Department of Emergency Medicine, Chang Gung Memorial Hospital, keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Am J Emerg Med. 2013 Jun;31(6):935-41. doi: 10.1016/j.ajem.2013.03.008. Epub 2013 Apr 17.
Infective endocarditis (IE) is a diagnostic challenge. We aimed to systemically summarize the current evidence on the diagnostic value of procalcitonin (PCT) in identifying IE.
We searched EMBASE, MEDLINE, Cochrane database, and reference lists of relevant articles with no language restrictions through September 2012 and selected studies that reported the diagnostic performance of PCT alone or compare with other biomarkers to diagnose IE. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models.
We found 6 qualifying studies that included 1006 episodes of suspected infection with 216 (21.5%) confirmed IE episodes from 5 countries. Bivariate pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios were 64% (95% confidence interval [CI], 52%-74%), 73% (95% CI 58%-84%), 2.35 (95% CI 1.40-3.95), and 0.50 (95% CI 0.35-0.70), respectively. Of the 5 studies examining C-reactive protein (CRP), the pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios were 75% (95% CI 62%-85%), 73% (95% CI 61%-82%), 2.81 (95% CI 1.70-4.65), and 0.34 (95% CI 0.19-0.60), respectively. The global measures of accuracy, area under the receiver operating characteristic curve (AUC) and diagnostic odds ratio (dOR), showed CRP (AUC 0.80, dOR 8.55) may have higher accuracy than PCT (AUC 0.71, dOR 4.67) in diagnosing IE.
Current evidence does not support the routine use of serum PCT or CRP to rule in or rule out IE in patients suspected to have IE.
感染性心内膜炎（IE）的诊断极具挑战性。我们旨在系统总结目前关于降钙素原（PCT）在识别 IE 方面的诊断价值的证据。
我们在 2012 年 9 月之前通过无语言限制地在 EMBASE、MEDLINE、Cochrane 数据库和相关文章的参考文献列表中进行了搜索，并选择了单独报告 PCT 或与其他生物标志物比较以诊断 IE 的诊断性能的研究。我们使用森林图、分层汇总受试者工作特征曲线和双变量随机效应模型来总结测试性能特征。
我们发现了 6 项符合条件的研究，这些研究共纳入了来自 5 个国家的 1006 例疑似感染患者，其中 216 例（21.5%）确诊为 IE 患者。双变量汇总的敏感性、特异性、阳性似然比和阴性似然比分别为 64%（95%置信区间[CI]，52%-74%）、73%（95% CI，58%-84%）、2.35（95% CI，1.40-3.95）和 0.50（95% CI，0.35-0.70）。在 5 项研究中检测 C 反应蛋白（CRP），汇总的敏感性、特异性、阳性似然比和阴性似然比分别为 75%（95% CI，62%-85%）、73%（95% CI，61%-82%）、2.81（95% CI，1.70-4.65）和 0.34（95% CI，0.19-0.60）。准确性的全球衡量指标、受试者工作特征曲线（ROC）下的面积（AUC）和诊断比值比（dOR）显示，CRP（AUC 0.80，dOR 8.55）可能比 PCT（AUC 0.71，dOR 4.67）在诊断 IE 方面具有更高的准确性。
目前的证据不支持常规使用血清 PCT 或 CRP 来排除或确诊疑似 IE 患者的 IE。
